Blood Pressure - Help! « Back to Group Discussions

[2011mama]

Anyone else get vastly different readings at their prenatal care provider versus other places? I've been seeing a midwife and she's been telling me my blood pressure is getting higher. I am planning a home birth and if my BP gets to be 140/95 I cannot have a home birth so of course this is very important to me to keep it low! I've also been seeing a doctor due to hurting my wrist back in June and I saw my family doctor once during that time as well. The readings with the midwife seem to be getting higher and higher but yet at the other places they're normal.

I am in the process of getting the supplies I need to check my BP at home; she said if I did that she'd review my logs but also warned me I'd get lower readings at home (not sure if she meant they'd be artificially low?). First I bought a wrist monitor; it was terribly inaccurate. Don't ever waste your money! I returned that! It was giving me readings of like 90/60. Yeah, right. Then I bought the upper arm kind that you pump up but due to my size I have to get a larger cuff. The store I bought that at didn't have the larger cuff so I bought the cuff at a different store but it doesn't fit; they're not compatible. So now I have to order the larger cuff online to match the BP monitor. It's all just taking so long and my next midwife appointment is next week so I won't really have much to show her and we're getting into those last few weeks where she might have to make a decision soon as to whether I can HB or not.

Here are my readings for the past three months.

7/6 (midwife): 122/78 (last time it was "normal" before going up)
8/3 (midwife): 130/88 (This was first day it was high but I had sat through traffic from two accidents and was 25 minutes late to my apointment which I thought may have something to do with it.)
8/4 (wrist doc): 128/82 (very next day - a good amount lower I think)
8/15 (family doc): 125/75 (back to my "normal" I think)
8/31 (midwife): 132/80
9/1 (wrist doc): 124/80
9/14 (midwife): 130/90

9/29 (wrist doc): 122/78

Any theories on why my BP could be so different from place to place? Would you call these normal fluctuations? It seems they are always pronounced "good" at wrist doc and family doc but "high for me" at the midwife. I do have a long ride to my midwife's office and I know the first time it was high I was super late and had been stuck in traffic for awhile. The next time it was up again though there was nothing really going on. I don't know if just being there makes me nervous. You think I'd be more nervous at the wrist doctor since I hurt my wrist at work and everyone was acting so weird about it (like, "Oh, this is a pregnancy problem and she's trying to make a WC claim out of it," was the vibe I was orgiinally getting).

Oh, and things I've been doing to try to lower it since the 14th - more OJ, more blueberries, more whole foods, cut back on processed foods (I know, I shouldn't be eating those anyway!), cut back on restaurant meals (we had four homecooked dinners in a row this week so far), calcium magnesium zinc supplements, and passionflower extract. I never add salt to anything so I haven't really cut back on that since I didn't think it was a problem anyway. My midwife wants me to walk more but I'm having lots of hip and pelvic pain which are complicating matters!
 

[Abraisme]

I'm not sure what method each place is using, but I do know that I've gotten different reading based on WHO is taking my BP.  At one midwife appointment the apprentice took my bp and got something like 120/85 which is very high for me.  A few minutes later the other midwife checked it and it was 100/70 or something like that.  I think that there may be some human error involved here, but really the only way to tell is to use the same method every day.  I think that the home monitor is a good idea, since it will be consistent.

[birdhappy85]

I get different readings at the hospital in my clinical midwife's office than I do with my regular OP midwife and everywhere else. I'm usually around 110/60-ish, but for some reason every time I go to that hospital my BP is >130/80-ish! Of course since it's a medical setting, then they get concerned, and it frustrates the heck out of me. I tell them that my BP must be higher from walking the long distance from the parking garage to the office because I have no other explanation for it besides their monitors being wonky. I think I tense up in hospitals anyway so that doesn't help.

I'm sorry you're having such a difficult time with BP monitors and fluctuations! I'm not an expert on any of this, but your readings don't seem so high to be overly alarming... What does your midwife say about the difference in your BP when you have it taken elsewhere? Your wrist doc's readings are much better, after all! Do you have any other signs of pre-eclampsia? Are your urine tests coming out okay?

[2011mama]

They're all using a pretty basic cuff that goes on the upper left arm and then they pump it up. Of all places for it to be high I wish it did not have to be the midwife's. :(

[KayPea]

It sounds like "white-coat syndrome" to me. Your BP goes up at the midwives because that is the one place where it actually matters what your BP is, in order for them to be OK with your homebirth. Just that situation is stressful enough to raise your BP. My mom has high blood pressure, but she also has white coat syndrome, so they are always wanting to admit her when she goes for an appointment!

Have you tried going to your appointment significantly early (like 30-45 mins) and doing some relaxation techniques in the waiting room, or reading a book, or something you find restful and comforting. Try visualizations when you are actually getting the BP taken - like you would during labour (imagine open, relaxed blood vessels, water/blood flowing quickly and smoothly). Actually, many pain-coping techniques from labour can help lower BP, like unfocused awareness. 

[jbk21]

I totally agree with Kaypea re: white coat syndrome.  You could let her know your readings from the wrist doc, too.  Perhaps that way she'll see that it isn't always "so high".

[2011mama]

Sorry, birdhappy85, I totally didn't see your response and only replied to Abraisme. When I tell my midwife my BP is fine everywhere else she just kind of says "Hmmm." And then she'll tell me not to be concerned but that she just wants me to be aware that it's hard to get it down when you're pregnant and it's just something we need to keep an eye on. I can't even use the hospital excuse because when I go to her it's her office at her house so it feels very homey. But I literally drive 45+ minutes to get there in morning rush hour traffic and I'm the first appointment of the day so I walk right in, use the bathroom, and then I come back out, sit down and she takes my BP. I have no other signs of pre-e that I know of. When I get there and use the restroom she has me dip one of those little sticks in my urine. I think one of them does have something to do with pre-e but I'm not sure (and the other to do with glucose maybe?). It's just a little stick with a little yellow square and a little blue square. She always looks at it and says it looks good and then tosses it.

KayPea, yeah, you could be right about it going up because it's the one place it matters. Unfortunately, there is no waiting room. It's at her house and I'm her first appointment of the day since I work. My maternity leave will be starting in a few weeks though so my 37-week appointment and on could possibly be later in the day. If I get there early though and she doesn't have someone before me she'll just let me come in so there won't be time to relax but if someone's in there I can certainly just sit in the car and do some deep breathing and relaxing.

jbk, yeah, I have been letting her know my other readings. She really doesn't say much when I tell her. It's hard to read her when it comes to this. I totally trust her in every other way but this is one area where I'm getting upset. And then she reminds me not to get upset and tells me it's not worrisome yet, just something we need to keep an eye on.

I really appreciate all your responses!

[Lula's Mom]

Do you know if the midwife use a smaller cuff than the doctors?  I ask because you said that you needed the bigger one for your home machine, and my husband also needs the larger cuff on our home machine.  If he forgets and uses the regular one, his readings are higher.

[2011mama]

Lula's mom, yep, I asked her if she was using the large cuff and she said she was. Good question though.

[Jaimee]

I would suggest having your mw take it twice: once when she usually does and again at the end of the appointment.  I find that often the whole process of getting settled into the appointment can take a bit and if you're dealing with traffic anxiety, etc. it's not out of the realm of possibility that your BP is higher when you get there, but would be lower once you have the chance to relax.  I also find doing some simple visualization, closing my eyes, breathing deeply, etc. helps me to relax and lower my BP when I feel a bit stressed or anxious.

[Gemini529]

It's definitely a good idea to have your MW take it twice.  You probably will be more relaxed for the second reading.

Now correct me if I'm wrong, but I thought it was the top number (systolic) that was more likely to change when you are anxious/nervous, and the bottom number (diastolic) was more likely to stay stable.  When I had this issue last time, they were mostly concerned about the fact that my diastolic was also much higher than it had been before.  

I don't know that I'd jump to the conclusion of "white coat hypertension" since it seems as though their readings have gradually gone up.  You didn't seem to have it at the beginning of the pregnancy, so why would you have it now?  PIH is something that happens towards the end of pregnancy sometimes.  I had it at the end of my last pregnancy and didn't feel like there was anything wrong with me.  It was just something that happened and it can be very dangerous if it gets too high, even without full on pre e.

Also, since you said you have the wrong size cuff and feel as though the wrist readings were inaccurate, I would assume the doctors are getting a more accurate reading than an at home monitor.  You might be better off going to a drug store and trying out theirs to see what you get. Just make sure you go during a non stressful time.  

Edited by Gemini529 - 10/5/11 at 5:46am

[BananaBreadGirl]

I'm dealing with something similar. I always feel a bit nervous when getting BP taken, but I take deep breaths etc. and manage to keep in in the high end of normal.

After a really stressful week with some things going on with my family, I arrived almost late for an appointment, driving through road construction with an upset toddler. Whaddya know, my BP was high. And it's been high every appointment since, now that I'm paying attention to it. I can feel my heart start pounding harder about 10 minutes before the appointment and I just can't make it stop. Doesn't matter if I go to my midwives' office or she comes to my home (she's been doing extra checks since she also thinks it is something to keep an eye on). But when I get it taken at the machine at Walmart or the grocery store, it is always very normal.

After 3 or so times of it being high at her office and normal elsewhere, it seems like we both agree that it's probably just nerves. We're going to try having someone else take it.

I do the urine test strips myself at appointments, looking at glucose, ketones, leucocytes, and protein, and report the results to my midwife. Those things are always fine, except for one very early appointment where I was spilling some protein after not having a good breakfast.

I think it's very possibly inflated due to your nervousness (white coat)...earlier in pregnancy everything is more low-key, or maybe once you had one high reading you paid more attention to it after that. Or possibly it has risen a little, but not as much as your numbers are saying.

Could you get it checked by a friend in health care (one that won't freak out if it's high), or at a machine?

I totally understand the stress of not wanting to be risked out of a home birth (especially if you suspect your blood pressure is not actually high...obviously if it IS high, then the hospital might be the safest place for you or me). We don't have insurance, so a hospital birth would be very stressful financially as well as in other ways.

[2011mama]

Jaimee, good idea but I went today and I forgot to ask her to take it twice. :( I think today it was 135/90 or 130/95. I really can't remember now. I also found out today baby is probably breech so I was not a happy camper.

Gemini, don't you think it's odd though it's normal other places (like at family doc or WC doc) but not at midwife's? That's what I can't figure out. I did not include my home readings in this list at all because I know they're not accurate since I don't have the correct size cuff. All the readings I've listed have been either done by midwife or a doctor.

BananaBreadGirl, yep, after that one visit when I was late and stuck in traffic it was high and it's been high almost every time since then. Grrr. Next time I'll see her is home visit so I'm curious to see how it is when I'm at home.

[BananaBreadGirl]

Hope it will be more normal for you at home!  My baby is very transverse, so I feel for you there too! Heads down, babies!
 

Originally Posted by 2011mama 

Jaimee, good idea but I went today and I forgot to ask her to take it twice. :( I think today it was 135/90 or 130/95. I really can't remember now. I also found out today baby is probably breech so I was not a happy camper.

Gemini, don't you think it's odd though it's normal other places (like at family doc or WC doc) but not at midwife's? That's what I can't figure out. I did not include my home readings in this list at all because I know they're not accurate since I don't have the correct size cuff. All the readings I've listed have been either done by midwife or a doctor.

BananaBreadGirl, yep, after that one visit when I was late and stuck in traffic it was high and it's been high almost every time since then. Grrr. Next time I'll see her is home visit so I'm curious to see how it is when I'm at home.

[Gemini529]

Originally Posted by BananaBreadGirl 

Hope it will be more normal for you at home!  My baby is very transverse, so I feel for you there too! Heads down, babies! 

Originally Posted by 2011mama 

Jaimee, good idea but I went today and I forgot to ask her to take it twice. :( I think today it was 135/90 or 130/95. I really can't remember now. I also found out today baby is probably breech so I was not a happy camper.

Gemini, don't you think it's odd though it's normal other places (like at family doc or WC doc) but not at midwife's? That's what I can't figure out. I did not include my home readings in this list at all because I know they're not accurate since I don't have the correct size cuff. All the readings I've listed have been either done by midwife or a doctor.

BananaBreadGirl, yep, after that one visit when I was late and stuck in traffic it was high and it's been high almost every time since then. Grrr. Next time I'll see her is home visit so I'm curious to see how it is when I'm at home.

Yes, I do think that part is weird...but the diastolic number of 90-95 is also quite high.  From everything I've read, that number is less likely to fluctuate when you are in a stressful situation, but even if it is stress causing it to get that high, that would make me nervous.  I guess what would make me nervous is the idea that when I get stressed, that is how my blood pressure reacts...by going into the "danger zone".  When mine reached the 145/92 zone late in my last pregnancy, my doctors were very concerned and told me to stay put....they didn't even want me walking up the steps.  Maybe they were just being overly concerned.  

Also, do you go to the wrist doctor during the morning and the MW after a long day at work?  That could have an affect on it.  My blood pressure was always lower in the morning, and then as the day progressed, it would creep higher.  If I took it right before bed, after relaxing all evening, it was usually a bit lower, too.  Regardless of the reason why your BP is higher sometimes, though, it doesn't change the effect it could have on the baby and you when it happens, especially if it happens often.  

Oh, oops, I see you already answered that question about time of day.  I wish there were more answers I could give you!  It's hard when they tell you something COULD be serious, or it could just be nothing.  I know you really want a homebirth...I'm also sorry to hear that the baby is breech!  You need to hear some good news.  I hope everything works out and the MW is just getting you at your most stressed out point in the day. Maybe when you switch to afternoon appointments, you will get better results, since these are first thing in the morning.  Does the idea of going to work stress you out?  Maybe you are at your worst in terms of stress at that time of day.  

[2011mama]

Gemini, it'll be interesting to see. My last day of work was today. Yippee! I was at the chiropractor tonight and he took my BP (not something he normally does but I guess he just wanted to see) and it was 130/84. All my midwife appointments can now be scheduled later in the day I'd think (at least by my schedule). I don't have them scheduled yet so I'll try to get later in the day. Next week I see her at 9:30, which is an hour later than normal, but I'd like to see her even later for the rest. It is a long drive (40 miles) and the later in the morning (or early afternoon) I can go the better traffic will be.